El ekzaması tedavisinde yeni bir seçenek: topikal pimekrolimus

Özet

Meslek dermatozlar› aras›nda en s›k görülen tablo el ekzemalar›d›r. El ekzemalar›n›n kronik ve tekrarlay›c› seyrinden dolay› tedavisi hem hasta hem de hekim için sorun teflkil etmektedir. Topikal kortikosteroidlerin uzun süreli kullan›mlar›na ba¤l› yan etkilerinden dolay› yeni tedavi aray›fllar› do¤mufltur. Bu çal›flmam›zda askomisin türevi olan ve atopik dermatit tedavisinde güvenle kullan›lan topikal pimekrolimus %1 kremin el ekzemas› tedavisindeki etkinli¤ini de¤erlendirmeyi amaçlad›k. Gereç ve Yöntem: Plasebo kontrollü, randomize çal›flmam›zda bilateral el ekzemas› olan toplam 25 hastan›n her bir eline plasebo ve di¤er taraf›na pimekrolimus %1 krem uygulat›ld›. Çal›flman›n 2., 4., 6. ve 8. haftalar›nda tedaviye cevap klinik olarak de¤erlendirildi. Klinik de¤erlendirmede eritem, deskuamasyon, likenifikasyon, ödem, vezikülasyon, fissür oluflumu 0-4 aras›nda skorland›. Ayr›ca hastalar›n kafl›nt› de¤erlendirmesinde ayn› skorlama kullan›ld›. Tedavi s›ras›nda görülen yan etkiler de kay›t edildi. Hastalar 8 haftal›k tedavi dönemini takiben yaklafl›k 8 hafta süresince tedavisiz izlendi. Bulgular: Tedaviyi tamamlayan 9 erkek, 15 kad›n hastan›n yafllar› 18 - 63 aras›nda (ortalama yafl 35.79) de¤ifliyordu. Meslek gruplar› incelendi¤inde 14’ü ev han›m›, 4’ü sa¤l›k personeli, 3’ü ö¤retmen, 1’i polis, 1’i çiftçi ve 1’i tuhafiye malzemeleri imalatç›s› olarak de¤ifliyordu. Hastal›k süreleri 6 ay-20 y›l (ortalama 4.9 y›l) aras›nda idi. On üç hastada iritan kontakt dermatit, 11 hastada allerjik kontakt dermatit tan›s› saptand›. Pimekrolimus %1 krem hastalar taraf›ndan iyi tolere edilmifl ve hiçbir yan etki gözlenmemifltir. Tedavi sonu ilaç uygulanan ele ait toplam klinik skorlar plasebo uygulanan ele ait skorlar ile karfl›laflt›r›ld›¤›nda anlaml› bir azalma saptanm›flt›r (p=0.04). Sonuç: Sonuç olarak el ekzemalar›n›n tedavisinde topikal pimekrolimusun vezikülasyon d›fl›ndaki tüm belirtileri bask›lamada oldukça etkili, ribaund ve tafliflaksiye neden olmayan, kullan›m› kolay bir tedavi seçene¤i olabilece¤i sonucuna var›lm›flt›r. (Türkderm 2007; 41: 125-8)

Abstract

Hand eczema is the most common form of occupational dermatoses. Because of chronic and relapsing course, therapy is a problem for both physician and patient. New treatment alternatives have been investigated because of side effects of long-term topical corticosteroids use. In this study, we aimed to evaluate the efficacy of pimecrolimus 1% cream, an ascomisin derivative successfully used for atopic dermatitis, in the treatment of hand eczema. Material and Method: In this placebo-controlled, randomized study, pimecrolimus 1% cream was applied on one hand and placebo on the other hand of 25 patients twice daily for 8 weeks. Response to the therapy was assessed clinically at 2., 4., 6. and 8. weeks of the therapy. In the clinical assessment, erythema, desquamation, lichenification, edema, vesiculation and fissuring were scored between 0-4. Same scoring system was used also for the pruritus symptom of the patients. Side effects during the therapy were also recorded. The patients were followed for 8 additional weeks after the end of the therapy. Results: Nine male and 15 female patients with ages ranging from 18 to 63 (mean 35.79) completed the study. Of the patients, 14 were housewives, 4 were health workers, 3 were teachers, 1 was policeman, 1 was farmer and 1 was a haberdasher. The duration of disease ranged between 6 months and 20 years (mean 4.9 years). Diagnosis of irritant contact dermatitis was made in 13 patients and allergic contact dermatitis in 11 patients. Pimecrolimus 1% cream was well tolerated in all patients and no side effect was observed. The clinical score of pimecrolimus-applied hand improved significantly when compared with placebo applied hand (p=0.04). Conclusion: It is concluded that topical pimecrolimus cream appears to be an effective and easily appliable treatment alternative for all manifestations of hand eczema except for vesiculation, without any rebound and tachyphylaxis. (Turkderm 2007; 41: 125-8)